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One facility recently found that failing to get an estimate to a patient in timely fashion created more than a few headaches. This past January,
Each element of the rules has a specific portion to pay close attention to. 42 CFR Subpart C lays out the rules for “Suspension of
CMS incorrectly uses the term “observation.” As expected, the Centers for Medicare & Medicaid Services (CMS) released the 2023 Outpatient Prospective Payment System (OPPS) and
Benchmark rates for observation depend on understanding your numerator and denominator. First up, a shout-out goes to my friend Dr. Charles Locke in Maryland, an
Three quick stories, each of Medicare money that has vanished, never to be found. First, a report from the U.S. Department of Health and Human
Rumors persist of possible leadership changes at some Medicare Advantage plans in the mid-South region. From where I sit, which is very close to the
A recent survey has illustrated just how onerous the various federal regulations of healthcare have become. If you’re feeling extra productive and accomplished this morning
Always challenge the extrapolation. It is my opinion that extrapolation is used too loosely in healthcare audits. What I mean is that sample sizes are
Two key insurers were recently targeted for HHS OIG scrutiny. I was all set to dive into the September audits of HumanaChoice and BlueCross Blue
There are 50 Shades of Grey in federal prepayment review. I hate wishy-washy laws. If a law exists, in my mind, it should be specific.
Well, it appears I opened a real can of worms last week when I mentioned a DRG downgrade audit finding received by a hospital for
The updated guidelines, developed jointly by AHIMA and ACDIS, are expected to be announced today. The American Health Information Management Association (AHIMA) is expected to
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